Walley John, Lawn Joy E, Tinker Anne, de Francisco Andres, Chopra Mickey, Rudan Igor, Bhutta Zulfiqar A, Black Robert E
Nuffield Centre for Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Lancet. 2008 Sep 13;372(9642):1001-7. doi: 10.1016/S0140-6736(08)61409-9.
The principles agreed at Alma-Ata 30 years ago apply just as much now as they did then. "Health for all" by the year 2000 was not achieved, and the Millennium Development Goals (MDGs) for 2015 will not be met in most low-income countries without substantial acceleration of primary health care. Factors have included insufficient political prioritisation of health, structural adjustment policies, poor governance, population growth, inadequate health systems, and scarce research and assessment on primary health care. We propose the following priorities for revitalising primary health care. Health-service infrastructure, including human resources and essential drugs, needs strengthening, and user fees should be removed for primary health-care services to improve use. A continuum of care for maternal, newborn, and child health services, including family planning, is needed. Evidence-based, integrated packages of community and primary curative and preventive care should be adapted to country contexts, assessed, and scaled up. Community participation and community health workers linked to strengthened primary-care facilities and first-referral services are needed. Furthermore, intersectoral action linking health and development is necessary, including that for better water, sanitation, nutrition, food security, and HIV control. Chronic diseases, mental health, and child development should be addressed. Progress should be measured and accountability assured. We prioritise research questions and suggest actions and measures for stakeholders both locally and globally, which are required to revitalise primary health care.
30年前在阿拉木图达成的原则如今依然适用。到2000年实现“人人享有健康”的目标并未达成，而且如果不大幅加速初级卫生保健，大多数低收入国家将无法实现2015年千年发展目标。影响因素包括对卫生问题缺乏足够的政治重视、结构调整政策、治理不善、人口增长、卫生系统不完善以及对初级卫生保健的研究和评估匮乏。我们提出以下振兴初级卫生保健的优先事项。卫生服务基础设施，包括人力资源和基本药物，需要加强，并且应取消初级卫生保健服务的使用者付费，以提高利用率。需要为孕产妇、新生儿和儿童保健服务，包括计划生育，提供连续的护理。基于证据的社区和初级治疗及预防保健综合方案应根据各国国情进行调整、评估并扩大规模。需要社区参与以及与强化的初级保健设施和一级转诊服务相联系的社区卫生工作者。此外，将卫生与发展联系起来的部门间行动是必要的，包括改善水、环境卫生、营养、食品安全以及控制艾滋病毒方面的行动。应关注慢性病、精神卫生和儿童发育问题。应衡量进展情况并确保问责制。我们确定了研究问题，并为地方和全球的利益攸关方提出了振兴初级卫生保健所需的行动和措施。
